J. R. Dunne2, D. L. Hunt3, K. M. McBride2, C. Chen3, D. D. Watts1, J. Jacobs1, R. J. Wyse1, J. M. Garland1, L. F. Harbour1, S. M. Fakhry1 1HCA Healthcare, Center For Trauma And Acute Care Surgery Research, Nashville, TENNESSEE, USA 2Memorial Health University Medical Center, Department Of Trauma And Surgical Critical Care, Savannah, GA, USA 3TriStar Skyline Medical Center, Department Of Surgery, Nashville, TN, USA
Introduction: Antiplatelet agents (AA) have the potential to increase the risk of intracranial hemorrhage (ICH). It is unclear whether reversal of antiplatelet effects (REV=DDAVP+Platelets) decreases progression of traumatic ICH. The goal of this study is to determine if REV decreases the likelihood of acute progression of ICH on repeat brain CT scan.
Methods: This is a clustered observational study (11/19-3/22) at 2 regionally distinct trauma centers (TC) with differing standards of practice in patients with ICH, one REV+ and the other REV–. Using electronic and manual chart review, data were collected on adult (>18 yrs) inpatients on preinjury AA with CT proven ICH (AIS Head >2) and no other AIS>2 injuries who had at least 1 repeat CT scan within 120 hours of admission. Rates of ICH progression on repeat brain CT scan (new ICH or increase in existing ICH), mortality and resource utilization were compared via univariate analysis (α=.05).
Results: 114 patients were enrolled: 72 REV+ at the first TC and 42 REV– at the second TC. REV+ group had fewer White patients and a lower proportion on preinjury ASA but were similar on other characteristics (Table). ICH progression rate was 24/72 (33.3%) in REV+ and 11/42 (26.2%) for REV–, p=.43. Isolated SAH was the most common lesion, followed by isolated SDH. No patients required cranial surgery. All-cause mortality (expired+hospice) was 5/72 (6.9%) and 1/42 (2.4%) respectively, p=0.29.
Conclusion: In this study of patients on preinjury AA, REV was not associated with a decreased rate of ICH progression, lower mortality or less resource utilization. Due to limitations of sample size and generalizability these findings should be confirmed in a larger, prospective study.
